Class: alpha-Adrenergic Blocking Agents
VA Class: CV150
Chemical Name: Piperazine, 1-(4-amino-6,7-dimethoxy-2-quinazolinyl)-4-((tetrahydro-2-furanyl-)carbonyl)-, monohydrochloride, dihydrate
CAS Number: 70024-40-7
Brands: Hytrin
Introduction
Postsynaptic α1-adrenergic blocking agent; quinazoline derivative.1 2 3 4 5 6 7 8 9 10
Uses for Terazosin Hydrochloride
Hypertension
Management of hypertension (alone or in combination with other classes of antihypertensive agents).1 3 4 6 7 8 11 12 13 14 30 31 32 44
Current antihypertensive and urology guidelines (e.g., JNC 7) no longer recommend α1-blockers as preferred first-line therapy for patients with hypertension.62 73 74 75
Benign Prostatic Hyperplasia (BPH)
Reduction of urinary obstruction and relief of associated manifestations in patients with symptomatic BPH.1 5 9 17 18 21 23 25 33
Although drug therapy usually is not as effective as surgical therapy, it may provide adequate symptomatic relief with fewer and less serious adverse effects compared with surgery.59
May consider combined therapy with an α1-adrenergic blocker and 5α-reductase inhibitor for men with bothersome moderate to severe BPH and demonstrable prostatic enlargement.59 Has been more effective than therapy with either drug alone in preventing long-term BPH symptom progression.59 Men at risk for BPH progression are most likely to benefit from combination therapy.59
Terazosin Hydrochloride Dosage and Administration
Administration
Oral Administration
Administer orally once daily at bedtime.1
Food may delay time to peak plasma concentrations by about 40 minutes but has little effect on extent of absorption.1 28 Manufacturer makes no specific recommendations regarding administration with meals.1
Dosage
Available as terazosin hydrochloride; dosage expressed in terms of terazosin.1
Individualize dosage according to patient response and tolerance.1 3 7 44 Initiate at low dosage to minimize frequency of postural hypotension and syncope.1
Monitor BP 2–3 hours after dosing and at end of dosing interval to determine whether peak and trough responses are similar and to assess potential manifestations (e.g., dizziness, palpitations) of an excessive response.1
If therapy is interrupted for several days or longer, restart using initial dosage regimen.1
Pediatric Patients
Hypertension†
Oral
Initially, 1 mg once daily.76 Increase dosage as necessary up to a maximum of 20 mg once daily.76
Adults
Hypertension
Oral
Initially, 1 mg daily at bedtime.1 3 7 44 62 May increase dosage gradually to 5 mg daily,1 3 7 with further titration up to 20 mg daily if BP is not controlled.1 44 62
Each increase should be delayed until BP has stabilized at a given dosage.1 3 7
BPH
Oral
Initially, 1 mg daily at bedtime.1 9 May increase daily dosage to 2 mg and thereafter to 5 mg and 10 mg, if necessary, to reduce symptoms and/or improve urinary flow rates.1 9
Prescribing Limits
Pediatric Patients
Hypertension†
Oral
Maximum 20 mg daily.76
Adults
Hypertension
Oral
Maximum 40 mg daily.1
BPH
Oral
Maximum 20 mg daily.1
Special Populations
Hepatic Impairment
Manufacturer makes no specific dosage recommendations; effects on the pharmacokinetics of terazosin have not been elucidated.1
Renal Impairment
Clinically important alterations in the pharmacokinetics of terazosin not observed to date;1 3 28 29 dosage adjustment not necessary.3 28 29 33
Administration of supplemental doses of the drug following hemodialysis does not appear to be necessary.1
Geriatric Patients
Use with caution; generally, increase dosage more slowly in geriatric patients than in younger adults.7 9
Cautions for Terazosin Hydrochloride
Contraindications
Known hypersensitivity to terazosin, quinazolines (e.g., doxazosin, prazosin), or any ingredient in the formulation.1 33
Warnings/Precautions
Warnings
Postural Hypotension
Marked hypotension, especially in the upright position, can occur; may be accompanied by syncope, palpitations, and other postural effects (e.g., dizziness, lightheadedness, vertigo).1 2 3 4 6 7 9 13 30
Postural effects are most common after an initial dose, shortly after dosing (e.g., within 90 minutes), when dosage is increased, or when therapy is resumed after an interruption exceeding a few days.1
To decrease risk of excessive hypotension and syncope, initiate therapy at low dose and titrate carefully, lessen level of salt restriction, and avoid diuretics just prior to initiation of terazosin therapy.1 3 4 6 7 30
Priapism
Priapism reported rarely; may lead to permanent impotence if not treated promptly.1 48 49 (See Advice to Patients.)
General Precautions
Prostate Cancer
Exclude possibility of prostate cancer before initiation of therapy for BPH.1 9
Specific Populations
Pregnancy
Category C.1
Lactation
Not known whether terazosin is distributed into milk.1 Caution if used in nursing women.1
Pediatric Use
Safety and efficacy not established in patients <21 years of age.1 33
Geriatric Use
Geriatric patients may be particularly susceptible to postural effects and other adverse effects.7 9 (See Geriatric Patients under Dosage and Administration.)
Common Adverse Effects
In the treatment of hypertension: dizziness, headache, asthenia (weakness, tiredness, lassitude, fatigue), nasal congestion, peripheral edema, somnolence, nausea, palpitation.1 3 4 6 7 13
In the treatment of BPH: dizziness, asthenia, headache, postural hypotension, somnolence.1 9
Interactions for Terazosin Hydrochloride
Antihypertensive Agents
Possible rapid fall in BP and exacerbation of postural effects.1 7 9 Use with caution; may need to reduce and/or retitrate dosage.1 7
Specific Drugs
Drug | Interaction |
|---|---|
Acetaminophen | No interaction observed1 |
β-Adrenergic blocking agents (e.g., atenolol, propranolol) | No interaction observed1 |
Allopurinol | No interaction observed1 |
Antacids | No interaction observed1 |
Antihistamines (e.g., chlorpheniramine) | No interaction observed1 |
Captopril | Increased peak plasma concentrations of terazosin1 |
Codeine | No interaction observed1 |
Corticosteroids | No interaction observed1 |
Co-trimoxazole | No interaction observed1 |
Diazepam | No interaction observed1 |
Diuretics, thiazide (e.g., hydrochlorothiazide) | No interaction observed1 |
Erythromycin | No interaction observed1 |
Hypoglycemics | No interaction observed1 |
NSAIAs (e.g., aspirin, ibuprofen, indomethacin) | No interaction observed1 |
Sympathomimetic (adrenergic) agents (e.g., phenylephrine, pseudoephedrine) | No interaction observed1 |
Verapamil | Increased AUC of terazosin; decreased time to peak plasma terazosin concentrations1 |
Terazosin Hydrochloride Pharmacokinetics
Absorption
Bioavailability
Rapidly and almost completely absorbed from the GI tract following oral administration.1 2 Peak plasma concentration attained in about 1 hour.1
Food
Food has minimal effect on extent of absorption; however, time to peak plasma concentration is delayed by about 40 minutes.1 28
Distribution
Extent
Not known whether terazosin is distributed into breast milk.1
Plasma Protein Binding
90–94%.1 a
Elimination
Metabolism
Extensively metabolized in the liver,a with minimal first-pass metabolism.1
Elimination Route
Excreted in urine (40%) and in feces (60%).1
Half-life
Adults: approximately 12 hours.1
Geriatric patients: approximately 14 hours.1
Special Populations
In geriatric patients, plasma clearance is decreased by about 30%.1
Stability
Storage
Oral
Capsules
20–25°C.1 Protect from light and moisture.1
ActionsActions
Reduces peripheral vascular resistance and BP as a result of vasodilating effects; produces both arterial and venous dilation.1 3 4 6 7 10
Binds to α1-adrenergic receptors in the prostate and the bladder trigone, resulting in decreased urinary outflow resistance in men.5 9
May improve to limited extent the serum lipid profile (e.g., small increases in HDL/total cholesterol ratio; small decreases in LDL, total cholesterol, and triglyceride concentrations).1 3 7 8 9 10 11 28 31 32
Advice to Patients
Possible syncopal and orthostatic symptoms, especially at initiation of therapy; importance of avoiding driving or other hazardous tasks for 12 hours after first dose, a dosage increase, or when resumed after therapy interruption.1 9
Importance of sitting or lying down when symptoms of lowered BP occur, and of rising carefully from a sitting or lying position.1
Importance of informing clinician if bothersome dizziness, lightheadedness, or palpitations occur.1
Possible drowsiness or somnolence; use caution when operating machinery or driving a motor vehicle until effects on individual are known.1 9
Importance of men seeking medical treatment if painful or sustained (for hours) erection occurs.1 48 49
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as concomitant illnesses.1
Importance of advising patients of other important precautionary information.1 (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Oral | Capsules | 1 mg (of terazosin)* | Hytrin (with parabens and povidone) | Abbott |
2 mg (of terazosin)* | Hytrin (with parabens and povidone) | Abbott | ||
5 mg (of terazosin)* | Hytrin (with parabens and povidone) | Abbott | ||
10 mg (of terazosin)* | Hytrin (with parabens and povidone) | Abbott |
Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Terazosin HCl 1MG Capsules (MYLAN): 30/$14.45 or 90/$33.98
Terazosin HCl 10MG Capsules (SANDOZ): 30/$13.99 or 90/$33.99
Terazosin HCl 2MG Capsules (SANDOZ): 30/$13.99 or 90/$33.99
Terazosin HCl 5MG Capsules (SANDOZ): 30/$13.99 or 90/$33.99
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions April 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
References
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